Theuns Botha MPP
Western Cape Government
Yesterday, Western Cape Minister of Health, Theuns Botha, visited Mr Martin Stuurman at Groote Schuur Hospital after a kidney transplant on him on his 47th birthday, ten days ago on 20 August.
Mr Stuurman is from George in the Southern Cape.
It was the hospital’s 30th kidney transplant this year. The hospital performs average 60 kidney transplants per year, and Tygerberg Hospital performs about 25 kidney transplants per year, mostly from living donors and around one-third from deceased donors.
There is not a fixed budget for transplantation. The Western Cape Department of Health strives to perform as many transplants as theatre time allows, and is also dependent on organ donors. Kidney transplants are the most cost-effective form of renal replacement therapy and it offers the patient the best quality of life.
A kidney transplant is much cheaper than maintaining a patient on dialysis. Similarly a liver transplant is cheaper in the long run than treating the complications of chronic liver disease.
Approximate costs for dialysis is around R150, 000 per patient per year and for transplant patients it is approximately 30% less.
An important point is that we have too few nephrologists in SA – around 50 in total, which is about 1 per million of the population. The Western Cape state sector employs about 10 nephrologists.
Western Cape Government Health would ideally want to assist all patients who require dialysis treatment but are faced with the reality of limited resources. The Department are continually exploring innovative ways to address this. An example is partnerships with the private sector to assist to meet the ever-increasing demand.
When faced with limited capacity, it’s imperative to prioritise and it can be challenging for the selection committee to be placed in such a position to ultimately make a decision in this regard.
The Organ Donor Foundation promotes organ donation.
Transplant coordinators at Groote Schuur Hospital and at Tygerberg Hospital facilitate the process. The transplant coordinators approach families at the time of certification of brain death and ask whether they are willing to donate their loved ones organs and tissues. If they are willing to do so, it is clearly documented which specific organs they give consent for.
Most common organs are: heart, kidneys, lungs, liver, pancreas, eyes/corneas, and skin, bone and heart valves.
The Organ Donor Foundation is constantly trying to increase the awareness of the need for organ donation. At present South Africa does not have a donor registry.
There are more patients on the kidney transplant waiting list compared to hearts and livers. Please note that many young patients with kidney failure are sent home to die because there are only a limited number of places on dialysis. The dialysis places only become available when these patients receive a transplant.
Over the years, there have been thousands of patients who have undergone transplantation. With between 120 and 150 transplants being done in the Western Cape each year, and most patients surviving long term, it is apparent that there are hundreds of transplant patients being cared for.
SUMMARY ON THE SELECTION CRITERIA USED DURING THE ASSESSMENT PROCESS.
The major barrier to accessing dialysis is the high cost of the procedure.
Currently the annual cost of treatment is conservatively estimated at R100 000. Because of this access to dialysis treatment has had to be restricted. It is not possible for government to treat all patients who are in need of dialysis. To ensure equity and the optimal use of limited resources a priority setting process was established.
The first overriding principle of this policy was that a patient to be accepted on to dialysis must be a suitable transplant candidate. If a patient is accepted for dialysis only, then that space remains permanently blocked until the death of that patient.
A successful transplant, will free a space for a new patient. Each patient undergoes a full medical and psycho social assessment and their details are presented to the committee constituted by the referring doctor, the head of the unit, senior and junior kidney specialists, nurses, medical superintendent and senior social worker.
Based on this detailed assessment patients are categorized into those who are very likely to be successfully transplanted, those who may undergo a transplant but have other serious disease or problems whereby transplantation may be more complicated and those who are unable to undergo transplantation.
Those in the first category will always be accepted for dialysis even if the programme is full. The provincial government has guaranteed that these patients will receive dialysis. Those in the second category will be accepted once there is space available. Lastly in the third category patients will not be accepted under any circumstances. Typical examples will be patients who have serious drug addiction or who have advanced heart disease or other serious diseases. All aspects of the meeting are documented and if the patient or family is unhappy they can appeal to the medical superintendent for a review.